HUNGARY

For a stubborn arthritic knee or the burning of nerve pain, the relief may come from an unlikely place.
The fiery compound in Hungarian paprika can quiet pain, by first setting the nerves alight.

Paprika (capsaicin)  ·  Capsicum annuum  ·  Mechanism: capsaicin (TRPV1)

Paprika is the very soul of Hungarian cooking, the deep red ground pepper that colors goulash and pörkölt and sits on nearly every kitchen table in the country. It is made from dried and finely milled Capsicum peppers, in grades running from sweet and mild to fierce and hot, and the city of Szeged built its whole reputation and identity on it.

The peppers themselves came surprisingly late to Hungary, arriving from the Americas only a few centuries ago, but they were embraced so completely that paprika became a proud national emblem and symbol. What gives the hotter kinds their unmistakable fire is a single powerful compound, capsaicin.

Capsaicin is the chemical that makes any chili burn, an irritant the plant evolved to deter animals from eating its seeds. It sets off the body's own heat-and-pain alarm directly, which is precisely why a mouthful of hot paprika feels like genuine, physical, searing heat.

That sounds like just about the last thing you would ever want to rub on a sore, aching, inflamed knee or joint. And yet that is exactly where its most useful and best-proven role, by a wide margin, turns out to lie.

Capsaicin works by latching onto a receptor called TRPV1, the very same sensor that detects genuine heat, on the pain nerves right in your skin. Rubbed on repeatedly, it first makes those nerves fire, the familiar burn, and then, as they run down their supply of the chemical that signals pain, it quietly wears them out, so they transmit less pain than they did before, sometimes far less.

That is not folklore at all but genuinely established medicine. Capsaicin creams and high-strength patches have real, guideline-backed evidence for easing the pain of stubborn osteoarthritis and of nerve conditions like shingles and diabetic neuropathy, modest and not universal, to be sure, but genuine, and they work right where you rub them in, and nowhere else.

The compound that burns the nerve is the one that quiets it.

Eating it is a different and weaker story altogether. Chili in the diet is linked, in observational studies only, to slightly lower mortality and a small, pleasant metabolic lift, which is a nice bonus and no more, so the honest picture is a genuinely useful topical pain reliever for aching joints and nerves, and a tasty food with thin, hopeful health hints, not a cure taken by the spoonful at dinner.

The how-to

Use a capsaicin cream on the painful spot, expect a burn at first, and keep it away from your eyes.

For pain, use a topical capsaicin cream or gel, sold over the counter at low strength, around 0.025 to 0.075 percent, for arthritis and nerve pain, rather than eating chili and hoping. The high-strength eight percent patch is far stronger and is applied by a clinician, not at home.
Rub a small amount into the sore joint or painful area a few times a day, and stick with it, since the relief builds over one to two weeks of steady use as the nerves desensitize. A burning or warm feeling at first is normal and fades with continued use.
Wash your hands thoroughly afterward, or wear gloves, and keep it away from your eyes, nose, mouth, and any broken or irritated skin, since it stings fiercely on contact. Do not apply heat or a tight bandage over it, which can worsen the burn.
Expect modest, localized relief for arthritis or nerve pain, not a cure, and it helps some people far more than others. New, severe, or spreading pain, or numbness, deserves a doctor rather than a cream, and check with yours before using it over large areas or alongside other treatments.

Tomorrow: England and peppermint
the oil with genuinely strong trials for calming the cramps of irritable bowel syndrome.

See you then.